Atrius Health, one of 32 organizations selected in 2011 by the Centers for Medicare and Medicaid Services for its Pioneer Accountable Care Organization program, is a nonprofit alliance of six multi-specialty medical groups. It was created in 2004 to enable collaboration on new and better ways of delivering care, transform the delivery of health care in eastern and central Massachusetts, while maintaining an emphasis on care for the local community. The staff of over 7,200 employees includes 1,000 physicians and more than 1,425 healthcare professionals who service 3.8 million visits from over one million adult and pediatric patients at some 50 sites cross Eastern and Central Massachusetts.

HIMSS Analytics worked with Atrius Health to present its unique perspective on how the organization approached management and delivery of care to assigned beneficiaries. This white paper provides a benchmark of the approach Atrius took to manage two critical components of its Pioneer ACO: clinical and business intelligence.

Clinical Intelligence withAtrius Health – as a Pioneer ACO: The Atrius Pioneer ACO program has been assigned and services approximately 55,000 Medicare Advantage patients with about 70 percent of its revenues from risk-based patient populations. With that in mind, Atrius developed its own approach to managing these populations.

“We also adopted a relatively unique concept in that we wanted to take care of all of our patients exactly the same, no matter what their funding mechanisms were. So we’ve combined our ACO population with our Medicare Advantage population,” says Dr. Gene Lindsey, CEO, Atrius Health, in the white paper.

The organization has two primary goals for clinical intelligence:

To reduce Atrius Health’s cost to two percent under the official Medicare “reference population” trend, allowing Atrius Health access to its earned savings, which bends the cost curve two percent relative to the baseline population; and

To effectively report on the 33 quality metrics required of all Pioneer ACOs from the Innovation Center.

With these goals in mind, Atrius hired an ACO Executive Director to coordinate and manage the interaction between participating organizations and facilitate Pioneer ACO efforts. The executive director then established clinical workgroups to focus on four areas:

hospital strategy;

post-acute facility strategy;

home care strategy; and

geriatric care model design.

Each workgroup established its own goals, but used common reporting and benchmarking standards to ensure accountability for the workgroup and the overall ACO patient focus. Then, to build and sustain momentum, Atrius Health also established a monthly event called “ACO Day,” where all clinical leaders come together for a half day meeting with updates on current activities, separate workgroup meetings a learning collaborative with best practice presentations and discussions on a specific topic.

Business Intelligence withAtrius Health – as a Pioneer ACO: The provider groups at Atrius Health pay a fee for centralized IT services, thus enabling efficient IT management and economies of scale for pricing and support. As indicated in the white paper, the centralized approach also allows for investment in tools that increase value of the data, a benefit not possible with data and funding segregated by provider practice or facility location.

“Anything that we do clinically has to be supported with the business, both with an operationally efficiency and cost perspective, but as well with patient experience,” says Dr. Joe Kimura Medical Director of Clinical Reporting and Analytics, Atrius Health.

Dr. Kimura thus identified four primary business markets, beyond the 33 quality measures all Pioneer ACOs must report. Each of these markets – executive team/external partners; director and site-based administrators; physician and line managers; and patients – has a different level of maturity as well as needs for different types of data and access. The white paper reviews these markets and details current and planned-for business intelligence activities at Atrius Health.

In managing its Pioneer ACO capabilities, Atrius Health has: 1) leveraged its physician practice expertise; 2) developed a centralized and supportive IT department with a complete EMR and supporting data warehouse; 3) used strong communication and internal coordination; and 4) worked with its external partners, including hospitals and skilled nursing facilities, to set consistent standards, for normalized patient care with other organizations, to reach patients wherever they need care.

“The Atrius Health ACO provides a good contrast to our research and publication on how Banner Health approached clinical and business intelligence within the Pioneer ACO program. The organizations are quite different in focus, size, mission, and of course, the IT capital and resources they can access. Atrius Health uses astute negotiating with care partners combined with simple IT-based care coordination solutions to affect a dramatic, yet practical, impact on their ability to leverage clinical and business intelligence,” says James Gaston, Senior Director, Clinical and Business Intelligence, HIMSS Analytics.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.